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Critical Care
 
The goals of critical care medicine are to save the lives of patients with life-threatening but reversible medical or surgical conditions and to offer the dying a peaceful and dignified death. Open discussions between physicians and patients and their family members ensure that critical care is provided in a manner that is most consistent with the patient's wishes.
Respiratory Failure
General Considerations
  • Hypercapnic respiratory failure occurs with acute carbon dioxide retention [arterial carbon dioxide tension (PaCO2) >45รข€"55 mm Hg], producing a respiratory acidosis (pH <7.35).
  • Hypoxic respiratory failure occurs when normal gas exchange is seriously impaired, resulting in hypoxemia [arterial oxygen tension (PaO2) <60 mm Hg or arterial oxygen saturation (SaO2) <90%]. Usually, this type of respiratory failure is associated with tachypnea and hypocapnia; however, its progression can lead to hypercapnia as well. Hypoxic respiratory failure can result from a variety of insults, as shown in Table 8-1.
    • The acute respiratory distress syndrome (ARDS) is a form of hypoxic respiratory failure caused by acute lung injury. The common end result is disruption of the alveolar capillary membrane, leading to increased vascular permeability and accumulation of inflammatory cells and protein-rich edema fluid within the alveolar space.
    • The American-European Consensus Conference has defined ARDS as follows: (a) acute bilateral pulmonary infiltrates, (b) ratio of PaO2 to inspired oxygen concentration (FIO2) <200, and (c) no evidence for heart failure or volume overload as the principal cause of the pulmonary infiltrates.1

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